Hypertension: Choice of drugs for first-line therapy
DISEASE INTERVENTION COMPARISON RESULTS
Cochrane Database Syst Rev. 2012 Nov 14;11:CD002003. doi: 10.1002/14651858.CD002003.pub4 Systematic Review, Cochrane Review
IN Condition to be defined The Use of
beta blockers, mainly atenolol
As Treatment, Chronic
Is worse Than
placebo or other first choice antihypertensives
To modify the risk of total mortality or coronary disease (not different to placebo), stroke (reduced compared to placebo but increased compared to CCB and RAS inhibitors)
BMJ. 2009 May 19;338:b1665. doi: 10.1136/bmj.b1665 Meta-Analysis
IN hypertension, primary The Use of
5 main classes of blood pressure lowering drugs: thiazides, beta blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers
As Treatment, Chronic
Is better Than
placebo
To Prevent cardiac ischemic events, heart failure and stroke. Beta-blockers prevent better cardiac ischemis events after a myocardial infarction. Calcium antagonist had a marginal advantage for preventing stroke.
Ann Intern Med. 2008 Jan 1;148(1):16-29 Systematic Review
IN hypertension, primary The Use of
angiotensin II receptor blockers (ARBs)
As Treatment, Chronic
Is equal Than
angiotensin converting enzyme (ACE) inhibitors
To control blood pressure and to prevent death, cardiovascular events and kidney and heart disease. ACE inhibitors have higher rates of cough.
Lancet. 2002 Mar 23;359(9311):995-1003 Randomized Controlled Trial, Multicenter Study
IN hypertension, primary The Use of
angiotensin II receptor blockers, losartan
As Treatment, Chronic
Is better Than
beta blockers, atenolol
To reducing major cardiovascular events (death, myocardial infarction, or stroke): 23.8 per 1000 PYs in intv. / 27.9 per 1000 PYs in cont. Losartan reduces strokes and cardiovascular deaths but not myocardial infarction.
Lancet. 2005 Oct 29-Nov 4;366(9496):1545-53 Meta-Analysis
IN hypertension, primary The Use of
beta blockers
As Treatment, Chronic
Is worse Than
other first choice antihypertensives
To prevent stroke (RR 16% higher with beta-blockers than other drugs), myocardial infarction or overall mortality (no significant difference in AMI and mortality compared with placebo)
Lancet. 2000 Dec 9;356(9246):1949-54 Meta-Analysis
IN hypertension, primary The Use of
calcium channel blockers, first-generation
As Treatment, Chronic
Is worse Than
diuretics, beta blockers, angiotensin converting enzyme inhibitors, or clonidine
To acute myocardial infarction (OR 1,26 [95% CI 1·11-1·43]), congestive heart failure (OR 1·25 [1·07-1·46]), and major cardiovascular events (OR 1·10 [1·02-1·18])
JAMA. 2002 Dec 18;288(23):2981-97 Randomized Controlled Trial, Multicenter Study
IN hypertension, primary The Use of
diuretics, thiazides, chlortalidone
As Treatment, Chronic
Is better Than
angiotensin converting enzyme inhibitor (lisinopril), calcium channel blockers (amlodipine)
To prevent cardiovascular events: total and cardiovascular mortality did not differ. Higher rate of heart failure with amlodipine (10.2% vs 7.7% at 6 years). Higher rate of combined cardiovascular events with lisinopril (33.3% vs 30.9%)
J Am Coll Cardiol. 2011 Feb 1;57(5):590-600 Meta-Analysis
IN hypertension, primary The Use of
diuretics, thiazides, hydrochlorothiazide, low dose 12,5 -25mg /day, first line treatment
As Treatment, Chronic
Is worse Than
diuretics, thiazides, hydrochlorothiazide, higher dose 50 mg /day, or other 1st line anti-hypertensive drugs
To reduce mean blood pressure: 6.5 mmHg systolic /4.5 diastolic with 25 mg/day VS 12.0/5.4 mm Hg reduction with 50 mg/day.
Cochrane Database Syst Rev. 2009;(3):CD001841 Systematic Review, Cochrane Review
IN hypertension, primary The Use of
low-dose thiazide diuretics, angiotensin converting enzyme inhibitors (ACEI), and possibly calcium channel blockers
As Treatment, Chronic
Is better Than
high-dose thiazide diuretics, beta blockers
To reduce mortality, strokes and cardiovascular events
N Engl J Med. 2008 May 1;358(18):1887-98 Randomized Controlled Trial, Multicenter Study
IN hypertension, primary, elder patients The Use of
diuretic, indapamide, plus, if needed, angiotensin converting enzyme inhibitors (ACEI), perindopril
As Treatment, Chronic
Is better Than
placebo
To reduce mortality, cardiovascular mortality and stroke (absolute risk reduction not reported in abstract)
N Engl J Med. 2008 Dec 4;359(23):2417-28 Randomized Controlled Trial, Multicenter Study
IN hypertension, primary, high cardiovascular risk patients The Use of
combination of angiotensin-converting-enzyme (ACE) inhibitor, benazepril, plus a dihydropyridine calcium-channel blocker, amlodipine
As Treatment, Chronic
Is better Than
combination of an ACE inhibitor plus a thiazide diuretic
To reduce composite major cardivascular events at 3 years: 9.6% ACEI+amlodipine VS 11.8% ACEI+thiazide.